Contract Adherence Specialist

OneOncology is positioning community oncologists to drive the future of medical care through a patient-centric, physician-driven, and technology-powered model to help improve the lives of everyone living with cancer and other diseases. Our team is bringing together leaders to the market place to help drive OneOncology’s mission and vision.

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, urology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of independent physicians and the patients they serve.

Job Description:

Role Summary:

The Contract Adherence Specialist will be responsible for managing and maintaining fee schedule related aspects of Payer Reimbursement, including securing, loading, and auditing contracted fee schedule data for accuracy. In addition, this position will assist in identifying and resolving underpayment related issues for all applicable payers.

Responsibilities:

Knowledgeable and proficient in Claims billing procedures CPT and HCPCS codes

Demonstrates and applies expert level of knowledge of revenue cycle processes and concepts

Interpret contract reimbursement

Maintains documentation for contractual reimbursement for payers.

Maintains data in appropriate database

Evaluates actual reimbursement compared to defined contractual reimbursement rates for specific drugs/procedures.

Performs account audits

Manages payer log spreadsheets to be submitted to the health plans.

Identify trends in underpayments

Research and identify payment discrepancies from various sources

Performs reviews and assessments for underpaid claims

Compile and analyze data for recovery

Manage underpayment appeals and account follow-up

Resolve underpaid claims in an effective and timely fashion

Reports dollars and recovery efforts routinely to management

Additional responsibilities may be assigned to help drive our mission of improving the lives of everyone living with cancer.

Required Qualifications:

• •High School diploma or equivalent required.
• •Minimum five (5) years’ experience in accounts receivable, healthcare, or managed care preferred.

Essential Competencies:

Attendance is an essential job function.

Detailed knowledge of billing, HCPCS, CPT and ICD codes. Previous collections experience preferred

Exceptional Multi-tasking, organizational skills and attention to detail

Works well under deadlines and time sensitive projects while maintaining accuracy

Strong numeric and analytical skills

Self-motivated, able to work autonomously, multi-task and switch focus quickly

Excellent verbal and written communication skills

Strong knowledge of Windows-based software applications (E.g. Word, Excel, Outlook, Access)

Must possess high degree of professionalism and adaptability.

The above job description is a general overview of the responsibilities and competencies for this role at OneOncology. Specific details may vary based on the needs of the organization.

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